Monday, January 18, 2010
AGING SILICONE IMPLANTS
(1) Any palpable lump in the breast needs to be investigated
(2) Abnormal mammography, ultra-sound, or M.R.I. imaging that suggests leakage
(3) Hardness, pain, distortion in the breasts
(4) Patient concerns about silicone gel filled breast implants
(5) Underlying health problems that concern the patient
(6) Desire for change in size, or desire to change to saline implants
How about the patient that presents with 20+ year old silicone gel filled breast implants but has no symptoms and has a normal physical exam; is happy with the size, shape, contour & softness of the breasts; and has normal mammography and ultra-sound exams? This is a more difficult decision. Even though there is a high percentage of intra-capsular leakage, many times I may decide just to follow the patient closely. I do recommend avoiding any pressure on the breasts and would advise M.R.I. exams rather than mammography.
If the decision is made to proceed with revision augmentation mammoplasty, several options are available:
(1) Remove the implants and not replace implants
(2) Remove the implants, remove the internal scar tissue, and replace with saline filled implants
(3) Remove the implants, remove the internal scar tissue, and replace with the new fourth generation silicone gel filled implants (these implants were approved by the F.D.A. and released for general usage in November of 2006)
(4) Perform any of the above options with a breast lift
Revision augmentation mammoplasty is a major operation. This is done under general anesthesia and may take up to 3 hours. It is done at an accrediated outpatient surgical facility. It is more complicated than the original augmentation mammoplasty operation. Infra-mammary incisions (incisions in the crease under the breast) are used for access. The old implants and any leaking implant material is removed. The scar tissue is removed, and the pockets are enlarged and new implants are placed. Drains may be needed. The new fourth generation silicone implants have a better outer shell to contain the silicone gel. We do not have long term studies on these new implants and the F.D.A. is recommending periodic M.R.I. examinations to try to accumulate data on the leakage rate.
After surgery, the patient is wrapped in tight bandages that have to be worn around the clock for the first week. Most patients return to normal activities (work, school, driving, etc.) after the first week. The patient needs to limit any major physical activities (swimming, aerobics, exercising, upper body conditioning, excessive arm and shoulder movements, lifting over 5 pounds etc.) for the first 6 weeks. I see the patient a week after surgery to remove sutures and discuss additional postoperative care. Most patients are very happy with the results of revision augmentation mammoplasty.